Provider Demographics
NPI:1982153581
Name:HUNTERRORIE, KEISHA
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:HUNTERRORIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 W CLUB BLVD
Mailing Address - Street 2:623
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1104
Mailing Address - Country:US
Mailing Address - Phone:919-423-5376
Mailing Address - Fax:
Practice Address - Street 1:1058 W CLUB BLVD
Practice Address - Street 2:623
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1104
Practice Address - Country:US
Practice Address - Phone:919-423-5376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-25
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X174400000X
NC1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No174400000XOther Service ProvidersSpecialist